妇产科学-Medical Complications in Pregnancy.pptVIP

MEDICAL COMPLICATIONS IN PREGNANCY妊娠合并内科疾病 陈晓军 复旦大学附属妇产科医院 Heart Disease in Pregnancy 妊娠合并心脏病 I want a baby… 27 years old Atrial septal defect 1cm Feel discomfort only after ordinary activity Can I have a baby? What is the risk for me and my baby? What should I do during the course of pregnancy? By which way should I delivery my baby? Any special thing to be paid attention to after birth? Heart Disease Incidence:1-4% of pregnancies One of the leading causes of maternal death (8.3%) Death rate 0.6%-2.7% Classification of Heart Disease Congenital heart disease (先天性心脏病） Left-to right shunt Right-to left shunt Rheumatic heart disease （风湿性心脏病） Hypertensive heart disease Peripartum cardiomyopathy (PPCM) Myocarditis （心肌炎） Peripartum cardiomyopathy (PPCM) 围产期心肌病 Dilated cardiomyopathy occurs during the last 3 months of pregnancy to 6 months postpartum (increased heart size, decreased heart function) Etiology unknown No history of cardiovascular disease Die from heart failure, arrhythmia or pulmonary infarction 50% recover 6 months postpartum Recur in the successive pregnancy Clinical Implications ：10-30% of fetal death Therapy Treatment for heart failure Heart transplantation Clinical significance of heart disease in pregnancy Mother: heart failure; infective endocarditis; hypoxia and cyanosis; thrombenbolism Baby: miscarriage（流产）, still birth （死产）, fetal growth restriction （生长受限）, fetal and newborn distress （呼吸窘迫）, preterm delivery （早产） Increased caesarean section rate （剖宫产） Drug effect Hereditary congenital heart disease （先天性心脏病） Diagnosis of heart disease History Clinical indicators Electrocardiography Chest X-ray Echocardiography Diagnosis Clinical classification of cardiac capacity Class I: Uncompromised Class II: Slightly compromised Class III: Marked compromised Class IV: Severely compromised Management TO BE OR NOT TO BE Preconceptional counseling During Pregnancy Determine whether or not the pregnancy should be continued NO: induced abo